For those with Restless Leg Syndrome, a lack of sleep is likely a nightly occurrence. It’s also the most dangerous side effect of this frustrating condition.

Worse yet, many suffer from Restless Leg Syndrome and don’t know it.

RLS can often be misdiagnosed as another sleep disorder, depression, poor circulation, arthritis, back problems and even growing pains in children.

If you have extreme fatigue, trouble falling or staying asleep, depression or anxiety, take the time to keep reading.

WHAT IS RESTLESS LEG SYNDROME?

Restless Leg Syndrome (RLS) is a neurological condition characterized by an uncomfortable feeling in the legs (most commonly). The unpleasant feeling causes an intense urge to move the lower extremity in order to find relief. The sensation is more prominent at night and is often described as “bugs crawling up the legs.”

The side effects of RLS are more concerning than the condition itself, and include:

Insomnia
Extreme daytime fatigue
Increased use of sleeping medications or alcohol to sleep
Increased use of stimulants in order to function
Increased stress (likely due to lack of sleep) and anxiety

Restless Leg Syndrome, also known as Willis-Ekbom Disease or WED, is most common in middle to older-age women, although anyone can experience it. The National Sleep Foundation estimates up to 10% of adults suffer from RLS.

HOW IS RLS DIAGNOSED?

The International Restless Leg Syndrome Study Group requires the following clinical features to be present in order to confirm a diagnosis of RLS:

Strong urge to move the legs due to uncomfortable sensations in the leg(s)
Symptoms become worse during periods of rest or inactivity
Symptoms are partially or totally relieved by movement
Symptoms become worse in the evening or nighttime
Symptoms are not solely accounted for by another condition (i.e leg cramps, positional discomfort)

Perhaps the most important tool, though not always performed, is a test to determine your iron levels. The most accurate way to determine if iron deficiency plays a role in RLS is to measure ferritin. Ferritin is an iron binding protein in which low values (less than 50 ng/ml) indicate low iron storage in the brain (more on iron below).

IS RLS A GENETIC CONDITION?

First degree relatives are 3 to 6 times more likely to suffer from the condition and over 50 percent of affected individuals report having at least one immediate relative with the condition.

Studies suggest when children experience RLS (early onset) it is more likely due to genetics as opposed to onset later in life (after the age of 45). Several gene variations have been studied as possible contributors to RLS, including the following genomic regions: BTBD9, MAP2K5, MEIS1, PTPRD, SKOR1 and TOX3.

Risk allele BTBD9 is associated with RLS and decreased peripheral iron stores – a well-defined environmental factor in which the risk of RLS is about 9 times greater than the general populations.

A change in the BTBD9 gene is present in about 75% of patients who have RLS but also present in about 65% of patients who don’t have RLS…

The difference? Environmental factors.

It’s the environmental triggers in combination with the right genes that trigger Restless Leg Syndrome.

Genetics alone rarely tell the whole story (and that holds true for each of the autoimmune conditions we’ve covered).

TRIGGERS FOR RESTLESS LEG SYNDROME

Caffeine – Caffeine, most commonly found in coffee, tea, chocolate, and soda may aggravate the symptoms of RLS. For many, caffeine activates excitatory neurotransmitters and has an arousal effect on the central nervous system. Ultimately, it’s effects promotes motor activity and inhibits proper control of fine motor movements, worsening the symptoms of RLS.

Iron Deficiency – The most consistent finding and the strongest environmental risk factor associated with RLS is iron insufficiency. Studies suggest that restless leg syndrome is related to a deficiency of iron in certain parts of the brain despite normal levels in the blood. (See information on testing iron in the diagnosis section.)

Vitamin D Deficiency – One of the most common theories about the cause of RLS is impaired dopamine signaling, and vitamin D is now being researched for its role in this process. Several studies support the hypothesis that a deficiency of Vitamin D correlates with more frequent and more severe symptoms of RLS.

Diet – Vitamin B12 is a critical part of a healthy nervous system, helping to maintain and protect the myelin sheath around the nerves. Researchers are led to believe it could play a role in the onset and treatment of RLS, due to its central role in our nervous system and brain.

A study published in the Journal of Postgraduate Medicine found both iron and vitamin B12 deficiencies to be common and treatable cause of RLS.

The best dietary sources of Vitamin B12 come from beef liver, grass-fed beef and eggs. But in order to absorb Vitamin B12, we must have adequate stomach acid levels and a healthy gut.

Stress – Chronic stress can alter cortisol production and lead to nighttime cortisol release, which researchers have found to be correlated with RLS. Stress levels can also decrease dopamine in the brain – a neurotransmitter necessary for smooth muscle activity and movement. When dopamine is decreased in the brain, it may cause movement problems seen in Parkinson’s disease and RLS.

Pregnancy – The prevalence of RLS during pregnancy is two to three times higher than in the normal population. Hormonal changes and iron status are the two main factors that may contribute to RLS during pregnancy.

Researchers have discovered another piece to the puzzle in the onset of RLS – systemic inflammation.

SYSTEMIC INFLAMMATION – THE CAUSE OF RESTLESS LEG SYNDROME?

What if the cause of those frustrating leg twitches is something you can’t see or touch… and is rarely a diagnosis you’d receive at the doctor’s office?

RLS is present in up to one third of MS cases and is also common in those with Crohn’s disease – a disease associated with iron deficiency, inflammation, and bacterial overgrowth. One study of 272 Crohn’s disease patients found 30% were affected by RLS.

The bottom line is this – we have to address the factors in our life that cause inflammation and the best place to start is a damaged gut.

A LEAKY GUT – THE MISSING LINK IN RESTLESS LEG SYNDROME?

You might wonder what the gut has to do with that uncomfortable feeling in your legs.

A damaged or leaky gut is a breeding ground for inflammation – the very inflammation that can lead to RLS.

A leaky gut allows conditions like SIBO (small intestine bacterial overgrowth), and irritable bowel syndrome (IBS) to wreak havoc on the body and contribute to things like RLS.

One study found 69% of RLS patients had SIBO while 28% also suffered from IBS symptoms (i. e. gas, cramping, bloating, and changes in bowel habits).

SIBO can lead to systemic inflammation and autoimmune changes (which can result in the nerves being attacked in RLS) and SIBO induced inflammation can increase hepcidin (the main hormone responsible for regulating iron).

No matter which way we look at it, inflammation is the common denominator.

So, how do we stop the inflammation that can lead to Restless Leg Syndrome?

Considering the overwhelming amount of research on the topic of systemic inflammation and a leaky gut, your gut is too important to be ignored.

However, a large majority of the medical community has yet to accept the role of the gut in the fight against RLS.

THE MEDICAL APPROACH TO TREATING RESTLESS LEG SYNDROME

Dopaminergic agents are often the first line of treatment in RLS. These drugs work to increase dopamine in the brain and include Requip, levodopa, and Neupro to name a few.

Known for their short-term effectiveness, they come with a long-term effects.

Augmentation is the most common side effect of dopaminergic drugs and occurs when the symptoms of RLS become more severe, happen earlier in the day, and spread to other parts of the body (i.e arms).

It’s estimated that over 80% of patients receiving levodopa for RLS develop augmentation.

With augmentation, the brain sees the extra dopamine (via medication) as a signal to decrease its natural production. The result? Patients become increasingly dependent on the drugs for relief.

Compulsive behavior is also a common side effect.

A study including 100 people with RLS (all were treated with dopaminergic agents) revealed well over 50% engaged in some type of compulsive behavior (ie. pathological gambling and compulsive eating habits).

After reading this, you may be wondering if there is a better way to treat RLS than the use of these dangerous medications.

THE LEAKY GUT – AUTOIMMUNE CONNECTION

If you’ve been keeping up with the latest information in natural health, you already know it’s nearly impossible to ignore a leaky gut as part of the cause and solution to autoimmune conditions like RLS.

Alessio Fasano, M.D. has been on the forefront of recent autoimmune disease research and published a paper titled “Leaky Gut and Autoimmune Diseases.”

His findings present the idea that in order for an autoimmune disease to develop, 3 conditions must all exist together:

For those with Restless Leg Syndrome, healing the gut means getting to the root cause so you can stop chasing your symptoms.

Healing a leaky gut is one factor that’s in our control and it can be done step-by-step with the right plan.

HOW TO TURN OFF AUTOIMMUNE DISEASE

Overcoming Restless Leg Syndrome requires a multifaceted approach to heal the gut and decrease inflammation – and that is exactly what we’re here to help you do.

Hippocrates, the famous Greek physician, stated “all disease begins in the gut,” and some 2,000 years later Fasano and many other leading experts agree.

Ancient and current wisdom both suggest that powerful healing must begin in the gut.

Jordan Reasoner is a health engineer and author. He was diagnosed with celiac disease in 2007 and almost gave up hope when a gluten-free diet didn’t work. Since then, he transformed his health using the SCD Diet and started SCDLifestyle.com to help others naturally heal stomach problems.

Below is another study that supports the idea of inflammation being at the core of Restless Legs Syndrome.

It’s an older study I recently ran across that dispensed low-dose hydrocortisone to a small study group to see if their RLS symptoms would improve. The results of the study showed that symptoms were significantly lessened.

I’ve included an overview of the study below.

I’ve also included an excerpt from a SECOND study that demonstrates the powerful anti-inflammatory properties of hydrocortisone.

AND PLEASE NOTE, this is NOT an endorsement of hydrocortisone as a solution for RLS. It’s simply more evidence supporting the idea that INFLAMMATION is the PRIMARY cause of RLS. Which means, logically speaking, as you lessen your inflammation, your RLS will lessen.

This lessening of inflammation can be done in a natural way through diet, lifestyle, proper digestion etc. It doesn’t have to be a pharmaceutical anti-inflammatory.

BACKGROUND

Circadian symptom manifestation in the evening and night is one of the main characteristics of restless legs syndrome (RLS). Although the inverse temporal course of corticosteroid rhythm and RLS symptom severity is obvious, this relationship has yet to be studied. We investigated the effect of late-evening application of exogenous cortisol (hydrocortisone) on sensory leg discomfort (SLD), one of the main complaints of patients with RLS.

METHODS

Ten untreated patients with idiopathic RLS participated in the study. Change of SLD was rated on a visual analogue scale during the 60 minutes resting period of the so-called Suggested Immobilization Test. Patients received either hydrocortisone 40 mg or placebo (saline) IV in random order in a double-blind crossover design, with 1 week between the experiments.

RESULTS

Severity of SLD was lower during hydrocortisone infusion than during placebo (p = 0.032). Though blind to the experimental condition, 5 of the 10 patients experienced improvement in symptoms during hydrocortisone administration, but no patient felt an amelioration during the placebo condition.

ABSTRACT

There is increasing evidence that the hypercortisolemia in inflammatory diseases suppresses the elaboration of *proinflammatory cytokines, thus protecting the host from its own defence reactions.

*A proinflammatory cytokine or more simply an inflammatory cytokine is a type of signaling molecule (a cytokine) that is excreted from immune cells like helper T cells (Th) and macrophages, and certain other cell types that promote inflammation from “Wikipedia Proinflammatory cytokine”

If you have followed this blog for awhile, or have visited my RLS website http://www.RLCure.com, you know that at the CORE of everything I present is that INFLAMMATION is the cause of RLS. In other words, eliminate the inflammation in your body and you will eliminate your RLS.

There are an ENDLESS number of ways in which inflammation can be introduced into your system, and there are unlimited ways in which it can be removed.

However, the REMOVAL requires a bit of effort and in most cases, a lot of sacrifice.

The articles below highlight how another anti-inflammatory agent has demonstrated success in lessening the effects of RLS.

Unfortunately for many of you, in this case the healing agent is MARIJUANA.

I want to make VERY clear that this post is not about promoting marijuana and endorsing it as a highly effective method to lessen your RLS symptoms. The idea of the post is to again emphasize that the KEY to your SUCCESS is to move towards an ANTI-INFLAMMATORY LIFESTYLE. That means that dietary, environmental, emotional, digestive changes etc. are required – anything that will move you away from continuing the inflammatory cycle that is at the heart of your RLS.

This is a total NON-ENDORSEMENT of smoking pot as a solution from yours truly, a man that has been in recovery from alcohol and drug addiction for over 30 years.

Smoking a DOOBIE may give you temporary relief, but unless you CHANGE your lifestyle, nothing permanent is going to take place. Your RLS will return.

Below are TWO articles. The FIRST one features a scientific study in which 5 out of 6 subjects had their RLS symptoms disappear thanks to the CHRONIC.

The SECOND article focuses on the tremendous anti-inflammatory properties of cannabis.

ARTICLE ONE

A small report published in the journal Sleep Medicine from the Bordeaux Hospital University Center in France is posing the question whether or not marijuana may help people with Restless Leg Syndrome to sleep better. The answer to that question is a crucial one for the 10-15 percent of people in the U.S. afflicted with the condition.

It’s easy to take sleep for granted when it’s working. When it’s not, it’s enough to drive you mad.

This is no secret for people who suffer from Restless Leg Syndrome (RLS). Even trying to classify the disorder is a challenge because it has crossover effect. It is sometimes classified as a sleep disorder because symptoms such as involuntary muscle twitching and jerking are initiated by inactivity or attempting to sleep. It can also be classified as a movement disorder because people affected sense an almost irresistible urge to move to reduce the uncomfortable sensation. But because the sensations originate in the brain, it could be argued that it is best identified as a neurological sensory disorder.

Regardless, to those who suffer from it, it means lack of sleep for starters. They can have a hard time both falling asleep and staying asleep. That lack of sleep impacts overall health, with negative impact on ability to concentrate, significant increase in daytime sleepiness and significantly lower productivity.

Sleep medicine expert, Dr. Imad Ghorayeb led the study.

Some subjects reported taking seizure medications clonazepam and gabapentin with unsatisfactory results. All subjects reported prior efforts to alleviate their condition with prescription opiates and dopamine agonists for their RLS. They were ready for a new approach because nothing had worked for them or even made situations worse. Two subjects had experienced compulsive shopping and binge eating as a result of using dopamine agonists.

To be fair, there were a meager six subjects in the study. However, 5 of the 6 reported that smoking marijuana relieved their symptoms completely; one reported complete loss of RLS symptoms after using cannabidiol (CBD).

Researchers could not claim to understand why cannabis worked so well in the small group. They do suspect that it is related to the herb’s pain relieving properties and the effect could be enhanced by the sleepiness marijuana can induce.

While the researchers were not willing to fully endorse marijuana for those with restless leg syndrome, they admitted all subjects reported it was the most effective remedy they had tried so far.

Though small scale studies such as this one may not prove anything yet, they do lay important groundwork and interest for more in depth research.

ARTICLE TWO

CANNABIS FOR INFLAMMATION, WHY DOES IS WORK SO WELL?by Dana Smith, cannabis.net

Medical Marijuana For Inflammation and Swelling Works Wonders

Living a lifestyle that prevents inflammation is necessary in preventing chronic illnesses. This means eating a proper diet high in nutrients and inflammation-fighting foods, getting enough rest as well as regular exercise. Once you do have inflammation, it’s important to address it immediately otherwise it can lead to more serious conditions. Most people actually aren’t aware that inflammation affects almost every aspect of your health: arthritis, celiac disease, cancer, asthma, fibromyalgia, heart disease, diabetes, thyroid problems, and ADD just to name a few. Inflammation can be happening right now in your body, but you won’t know it because it takes years for it to be clinically significant, or until it manifests through symptoms of another disease.

How Does Cannabis Treat Inflammation?

Numerous studies have proven that cannabis is effective in treating inflammation as well as addressing the accompanying pain. This is because of the presence of its 2 major cannabinoids, THC and CBD.

Both THC and CBD are effective in reducing inflammation that is linked to several diseases. But another compound found in cannabis called the beta-carophyllene also affects the CB2 receptor. A 2008 study analyzing mice who had swollen paws and were given oral doses of beta-carophyllene showed a 70% decrease in inflammation. The mice without CB2 receptors didn’t see any improvement.

A study published by the US National Library of Medicine found that cannabinoids control the response of the immune system and works in suppressing inflammatory responses. The human endocannabinoid system has 2 receptors: CB1, which is located in the central nervous system, is responsible for psychoactive effects; and CB2, which is found in the tissues and is responsible for inhibiting inflammation.

Cannabis is also useful in keeping c-reactive protein levels down; high levels of this protein can lead to fatal heart disease. A study published in the Drug and Alcohol Dependence Journal revealed that people who smoked cannabis had lower levels of c-reactive protein than those who didn’t smoke. Another study showed that CBD was effective in blocking the progression of rheumatoid arthritis and was also beneficial in providing relief for pain caused by joint swelling. It’s already well known that cannabis is effective in treating chronic pain, which is a side effect of inflammation.

While we now know that THC and CBD work in treating and preventing inflammation, they both work in the body in different ways. Both cannabinoids have demonstrated efficacy in decreasing both the release and production of pro-inflammatory cytokines and also works to decrease the activation of LPS-induced STAT 1 transcription factor, which contributes to some inflammatory processes. However scientists find that CBD is much more potent in addressing inflammation, and for this reason high CBD strains are recommended particularly for those who suffer from extreme inflammation. CBD actually supports the concentration of endogenous cannabinoids which gives the body the ability to self-heal and ward off disease.

Individuals with restless or unpleasant feelings in their legs at night or at rest, that are relieved by movement are needed. We are studying the possible benefits of yoga versus an educational film program for reducing symptoms of restless legs syndrome. Participants will attend up to two classes per week in Morgantown for 12 weeks. The study also involves two visits to WVU to complete questionnaires. Compensation is $150 upon completion of this research study. IRB approval on file (1505699758)

Restless legs syndrome is a seemingly unique condition and the cause is often difficult to pinpoint.

Few things are more frustrating than lying in bed at night, exhausted, but not being able to fall asleep because of an uncontrollable urge to move your legs. It seems so strange, doesn’t it? This phenomenon, known as restless legs syndrome (RLS), affects between 4% and 29% of adults in Western populations, and is a major contributor to sleep loss.

Pinpointing the cause of RLS has been an active research topic for years, but the condition is still not fully understood. The symptoms have been convincingly linked to impaired dopamine function in the brain, but the cause of this dysfunction is still being explored. Here are my top causes:

1. Systemic Inflammation & Immune Dysregulation (Subluxation)

One review paper published in 2012 investigated health conditions that were reported to cause or exacerbate RLS symptoms, and found that 95% of the health conditions that are associated with RLS have an inflammation or immune component. As further evidence, an elevated blood level of C-reactive protein (a marker of systemic inflammation) has been associated with increased RLS severity.

Researchers have proposed three potential mechanisms to explain the association between RLS and inflammatory or autoimmune states: direct autoimmune attack on the nervous system; genetic factors that could predispose an individual to RLS and be triggered by inflammation or autoimmunity; and vitamin D deficiency caused by inflammation, which I’ll talk more about below.

What to do: If your RLS is a symptom of underlying systemic inflammation or immune dysregulation, the goal should be to find and treat the root cause & reduce the stressors to the central nerve system and spine. Often we see the issue target to L5/S1 regions.

2. Small Intestinal Bacterial Overgrowth (SIBO) and IBS

A recent study found that 69% of RLS patients also had SIBO, compared with only 28% of control subjects. They also found that 28% of RLS patients had IBS, compared to only 4% of controls. And according to the 2012 review I mentioned above 32% of the health conditions associated with RLS are also associated with SIBO. As I’ve mentioned many times in the past neurological interference & gut infections are often the culprit—even if you don’t have noticeable symptoms—its worth getting your gut tested.

What to do: If you have RLS and suspect you may have SIBO or a gut issue its best to get tested to find our what is going on in there. Generally speaking, the intestines need to be flushed or cleansed then re-inoculated with healthy living strains of bacteria. Your typical probiotic won’t be able to do that. Overall the best approach is to follow a ketosis diet with bone broth until symptoms subside (and your SIBO tests are normal), and then gradually re-introduce fermented foods and probiotics.

3. Vitamin D Deficiency

One of the most-researched theories about the cause of restless legs syndrome is impaired dopamine signaling, which has led to the conventional treatment of RLS by dopamine agonists (i.e. chemicals that can bind to and activate dopamine receptors). Unfortunately, these treatments can become less effective over time, and can even result in a worsening of symptoms.

This is where vitamin D comes into play. The role of vitamin D in dopamine signaling is only beginning to be investigated, but some evidence indicates that vitamin D could play an important role by increasing levels of dopamine and its metabolites in the brain, as well as protecting dopamine-associated neurons from toxins.

RLS has been associated with vitamin D deficiency in several studies, and disease severity has been inversely correlated with vitamin D levels. One study has also found that vitamin D supplementation improved the severity of RLS symptoms.

What to do: If you have RLS, one of the easiest first steps you can take is to get your vitamin D levels tested. A good range to shoot for is typically between 40-60 ng/mL. If you have an autoimmune disease or another chronic health condition, optimal levels are between 60-80 ng/mL. One way to supplement vitamin D is through taking it directly. And of course, you should get regular sun exposure.

We’re still learning more and more about this syndrome, and hopefully we’ll come to some truly concrete answers soon enough. But as is so often the case, watching your nutrition and lifestyle goes a really long way in taking care of these sorts of issues.

Dr. Aaron Ernst completed his undergraduate education in pre-medicine/biology at Messiah University in Grantham, PA. As a first generation holistic practitioner, he began his career with a Doctorate in Chiropractic from Logan College of Chiropractic in Chesterfield, MO. While in Missouri, Dr. Aaron began helping patients rebuild their health in a Maximized Living Health center, which was the largest wellness clinic in Missouri. His experience has led him to spend countless hours studying and researching to create procedures and protocols to rebuild health naturally. Dr. Aaron has traveled all over North America, Europe and Africa teaching the principles of Maximized Living and educating all generations on gaining victory over disease naturally.

Below is an excerpt from an article titled “Inflammation and Pain Management with Magnesium” by Dr. Mark Sircus, Ac., OMD, DM (P), December 8, 2009

“According to the National Sleep Foundation approximately 70 million people in the United States are affected with sleeping disorders. Approximately 12 million Americans have Restless Legs Syndrome, a sleep and movement disorder characterized by unpleasant (tingling, crawling, creeping and/or pulling) feelings in the legs, which cause an urge to move in order to relieve the symptoms.

The above excerpt is a short but effective overview of the way that Restless Legs Syndrome feeds off itself; ever increasing the stranglehold it has over each individual.

The original RLS-causing inflammation in your body could have been created because of a number of issues. It’s likely that diet is involved, but there are many other possible contributors such as lifestyle, environment & toxins, alcohol consumption, stress, pregnancy, aging etc.

Once the inflammation inside you reaches a level that causes your legs to start tingling … a whole new (ugly) cycle begins!

The lack of sleep you begin to experience because of your wonky legs AS WELL AS the stress of the increasing frustration BOTH raise the existing inflammation level inside of you.

And, of course, as time goes on, it just gets worse. It’s an ugly, ugly debilitating cycle.

Yes, all the while, the RLS-causing inflammation inside of you increases, raising your inflammation and RLS to new levels.

THE SOLUTION:

Healing RLS requires a multi-pronged attack. You can’t just take a pill and wish it all away. Taking a prescribed medication expecting it to rid your RLS is like closing the door to a room that is on fire expecting the fire to die out.

The inflammation inside of you is going to continue to increase and manifest in other ways. (I explain how RLS is actually a warning signal from your body, on my website http://www.rlcure.com).

To rid yourself of RLS you need to:

1. Put a cork in where the inflammation is flowing into your life.

This means, first off, change your diet! Get the sugar, trans & saturated fats, gluten, alcohol, refined carbohydrates and MSG out of your life, as best you can. Give your body a chance to heal. It doesn’t have to be forever, just give it some breathing room to heal itself.

It also means that you need to learn to calm down.

Meditation, relaxation exercises and yoga have all been clinically proven to lower inflammation levels.

I still believe that no one is beyond help when it comes to RLS and inflammation. Regardless of how hopeless you think your situation is, if you’re willing to make necessary sacrifices and put in the work, you can be healed.

Whenever I run across something that has helped lessen a person’s RLS symptoms, whether it be a personal story or through a study, I know with 100% certainty that if I do a search on whatever it is they took to lessen their symptoms, that healing ingredient will have proven anti-inflammatory properties.

Such is the case with D-Ribose.

“D-Ribose is a naturally occurring five-carbon monosaccharide that is found in all living cells, and has anti-inflammatory effects in renal ischemia/reperfusion injury” (Ueki et al. 2013).

I ran across a RLS study that was done in 2008 that showed great promise in a father and son with Restless Legs that were both given D-ribose.

I am going to post the results of the study followed by some basic information about what D-ribose is.

I realize in the great theater of science that this study doesn’t prove anything. However, to someone still suffering from RLS that is trying to find the slightest glimmer of hope, this is yet more evidence shining its light on the DIRECT LINK between RLS and INFLAMMATION.

We report on two affected male individuals, a father and son, ages 71 and 47, from a family in which three generations carry the diagnosis. To evaluate any potential benefit of D-ribose in this condition, each individual orally consumed 5-g doses of D-ribose daily at different trial stages. Each stage lasted 3 weeks with a 2-week washout period between stages.

The initial stage involved a single 5 gm dose of D-ribose consumed at breakfast. Throughout the second stage, D-ribose was taken at breakfast and lunch. In the third stage, D-ribose was taken at all meals, breakfast, lunch, and dinner. Diaries by the subjects pertaining to their documentation and severity of restless legs syndrome symptoms was compiled. During the initial stage both men reported a general feeling of more energy and less fatigue, most notably after exercise, without any significant changes in their symptoms.

With the increase in the daily dose of D-ribose, in the second stage, their leg twitching and the feeling to move during the day was reduced for 1 subject, and rarely present in the other. Both still experienced the unpleasant sensations during the night.

However, during the final stage, a further increase in the daily dose of D-ribose eliminated their daily symptoms and the symptoms at night were of a lesser degree and had a later occurrence. Both men reported that D-ribose did not totally eliminate their discomfort, but the severity and onset of symptoms affecting their quality of life was substantially improved with D-ribose without any adverse reactions.

In looking at energy production, it helps to look at the “energy molecules” such as ATP, NADH, and FADH. These represent the energy currency in your body, and are like the paper that money is printed on. You can have all the fuel you want, but if it cannot be converted to these molecules, it is useless!

For years, I talked about the importance of B vitamins, which are a key component of these molecules. These helped to a degree, but it was clear that a key component was missing. In looking at the biochemistry of these energy molecules, they are also made of 2 other key components-adenine and ribose. Adenine is plentiful in the body and supplementing with adenine did not help CFS. We then turned our attention to Ribose. Ribose is made in your body in a slow, laborious process and cannot be found in food. We knew that CFS/FMS causes your body to dump other key energy molecules like acetyl-l-carnitine. We then found that the body did the same with Ribose, making it hard to get your furnaces working again even after the other problems were treated.

This was like one of those “Eureka!” moments where things came together. Not having Ribose would be like trying to build a fire without kindling—nothing would happen. We wondered if giving Ribose to people with CFS would jump-start their energy furnaces. The answer was a resounding yes!

Our recently published study (see the study abstract in Appendix B) showed an average 44.7% increase in energy after only 3 weeks (improvement began at 12 days) and an average overall improvement in quality of life of 30%. Two thirds of the CFS/FMS patients felt they had improved.19 Usually a 10% improvement for a single nutrient is considered excellent. A 44.7% increase left us amazed, and I am now recommending Ribose for all of my CFS/FMS patients, for athletes, and any one with pain, fatigue or heart problems. Ribose recently became available (over the counter) to physicians, and is one of the few natural products actually starting with physicians and then moving out into health food stores.

It is critical to use the proper dose for the first 3 weeks, which is 5 grams (5000 mg) three times a day. It can then be dropped to twice a day. I recommend the Corvalen form of ribose as it is the least expensive and highest quality and is packaged with a 5 gm dosing scoop in it. One 280 gm container will be enough to tell you if it will work. Corvalen M (which has ribose plus magnesium and malic acid) is also available, but if you are also taking the Energy Revitalization System vitamin powder (see chapter X), you are already getting the magnesium and malic acid, and the regular Corvalen is a better deal financially. Bioenergy, which makes Corvalen, also conducts almost all of the research on Ribose, knows the most about it, and has outstanding customer service in case you have any questions. Because of its importance, it’s worth looking at energy production and Ribose in greater detail. Having had the chance to explore the research and speak with a number of the researchers, below is what I’ve learned from them.

D-Ribose Accelerates Energy Recovery

D-Ribose (which is what I am referring to when I say ribose) is a simple, five-carbon sugar (known as a pentose by biochemists) that is found naturally in our bodies. But ribose is not like any other sugar. Sugars we are all familiar with, such as table sugar (sucrose), corn sugar (glucose), milk sugar (lactose), honey (predominantly fructose), and others are used by the body as fuel. These sugars are consumed and, with the help of the oxygen we breathe, are “burned” by the body to recycle energy. Because they are used excessively, they can also be toxic, as we’ve discussed earlier. Ribose, on the other hand, is special. When we consume ribose, the body recognizes that it is different from other sugars and preserves it for the vital work of actually making the energy molecule that powers our hearts, muscles, brains, and every other tissue in the body.

A key molecule, called adenosine triphosphate (or ATP for short), is known as the energy currency of the cell because the amount of ATP we have in our tissues determines whether we will be fatigued, or will have the energy we need to live vital, active lives. Ribose provides the key building block of ATP, and the presence of ribose in the cell stimulates the metabolic pathway our bodies use to actually make this vital compound. If the cell does not have enough ribose, it cannot make ATP. So, when cells and tissues become energy starved, the availability of ribose is critical to energy recovery.

Normal, healthy heart and muscle tissue has the capacity to make all the ribose it needs. When normal tissue is stressed by overexertion, several days of rest will usually allow it to fully recover. The muscle may be sore during recovery, as we frequently see for the three or four days after a hard day of yard work or after a weekend pick up football game, but eventually energy levels will be restored and the soreness will disappear. But when the muscle is chronically stressed by disease or conditions that affect tissue energy metabolism, the cells and tissues simply cannot make enough ribose quickly enough to recover. Hearts and muscles just don’t have the metabolic machinery they need to make ribose very efficiently. The result is chronic, persistent pain, stiffness, soreness, and overwhelming fatigue that may never go away.
The Link between Ribose, Energy, and Fatigue

Clinical and scientific research has repeatedly shown that giving ribose to energy deficient hearts and muscles stimulates energy recovery. One important study involved healthy athletes participating in high-intensity, endurance exercise over the course of one week. After exercise the energy level in the athlete’s muscle was reduced by almost 30%. Giving 10-grams of ribose per day for three days following exercise restored muscle energy levels to normal, while treatment with placebo provided virtually no effect.20 This study clearly showed that ribose stimulated the energy recovery pathways in the body, helping the muscle rebuild its energy supply quickly and completely. Even after three days of rest, muscle that was not treated with ribose remained energy starved and fatigued.

Two very interesting studies in animals showed how dramatic the effect of ribose could be on energy recovery in fatigued muscle. These studies were conducted by Dr. Ron Terjung, one of the top muscle physiologists in the U.S. In their research, Dr. Terjung and his co-investigators found that ribose administration in fatigued muscle increased the rate of energy recovery by 340% to 430%, depending on which type of muscle was tested.21 He also found that even very small amounts of ribose had the effect of helping the muscle cell preserve energy, a process known as energy salvage, and the higher the ribose dose, the more dramatic the effect on energy preservation.22 Although this groundbreaking research was done in animals it was instrumental in defining the biochemistry and physiology associated with the use of ribose in overcoming heart and muscle fatigue. But most of us with CFS and FMS are neither top athletes nor animals, so the question remains, “How will ribose affect me?”

Research in Ribose and CFS/FMS began with a case study that was published in the prestigious journal Pharmacotherapy in 2004.23 This case study told the story of a veterinary surgeon diagnosed with fibromyalgia. For months, this dedicated doctor found herself becoming more and more fatigued, with pain becoming so profound she was finally unable to stand during surgery. As a result, she was forced to all but give up the practice she loved.

Upon hearing that a clinical study on ribose in congestive heart failure was underway in the university where she worked, she asked if she could try the ribose to see if it might help her overcome the mind-numbing fatigue she experienced from her disease. After three weeks of ribose therapy she was back in the operating room, practicing normally with no muscle pain or stiffness, and without the fatigue that had kept her bedridden for many months.

Being a doctor, she was skeptical, not believing that a simple sugar could have such a dramatic effect on her condition. Within two weeks of stopping the ribose therapy, however, she was out of the operating room and back in bed. So, to again test the theory, she began ribose therapy a second time. The result was similar to her first experience, and she was back doing surgery in days. After yet a third round of stopping (with the return of symptoms) and starting (with the reduction of symptoms) the ribose therapy, she was convinced, and has been on ribose therapy since that time.

I found this report intriguing and decided to design the larger study in patients with fibromyalgia or chronic fatigue syndrome which I began to discuss earlier. Along with two research collaborators, I recently published a scientific paper describing the results of this research. The study we designed was intended to determine whether or not ribose would be effective in relieving the overwhelming fatigue, pain, soreness, and stiffness suffered by patients having this debilitating condition. Our study included 41 patients with a diagnosis of fibromyalgia or chronic fatigue syndrome who were given ribose at a dose of 5-grams three times per day for an average of three weeks. We found the ribose treatment led to significant improvement in energy levels, sleep patterns, mental clarity, pain intensity, and well being. Of the patients participating in the study, 65.7 % experienced significant improvement while on ribose, with an average increase in energy of 44.7% and overall well being of 30%- remarkable results from a single nutrient! 19 The only significant side effects were that 2 people felt too energized and hyper/anxious on the ribose. This is simply dealt with by lowering the dose and/or taking it with food.

To further validate these findings, we are currently conducting a much larger placebo controlled study, and hope to have the results published in the coming year. Interestingly, one of our study patients had an abnormal heart rhythm called atrial fibrillation. Ribose is outstanding in the treatment of heart disease as well, because it restores energy production in the heart muscle. Because of this, it was not surprising that this man’s atrial fibrillation also went away on the ribose and he was able to stop his heart medications as well! Because of its importance and the research showing marked heart muscle dysfunction (because of low energy) in CFS, let’s look at Ribose and the heart in more detail.